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General NPI Number Information
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NPI Number | 1366167397
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Entity Type | Individual
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Provider Name | MARLITA GAMBLE
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Gender | Female
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 42217 ANN ARBOR RD E
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City | PLYMOUTH
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State | MI
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Zip | 48170-4364
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Country | US
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Telephone | 734-737-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 42224 PARKSIDE CIR APT 202
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3363
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Country | US
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Telephone | 248-719-5829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451022580
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License Number State | MI
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